Mental health, financial, and social outcomes among older adults with probable COVID-19 infection: A longitudinal cohort study

Abstract

We investigated the immediate and longer-term impact (over 4-6 months) of probable COVID-19 infection on mental health, wellbeing, financial hardship, and social interactions among older people living in England. Data were analysed from 5146 older adults participating in the English Longitudinal Study of Ageing who provided data before the pandemic (2018-19) and at two COVID-19 assessments in 2020 (June-July and November-December). The associations of probable COVID-19 infection (first COVID-19 assessment) with depression, anxiety, poor quality of life (QoL), loneliness, financial hardship, and social contact with family/friends at the first and second COVID-19 assessments were tested using linear/logistic regression and were adjusted for pre-pandemic outcome measures. Participants with probable infection had higher levels of depression and anxiety, poorer QoL, and greater loneliness scores compared with those without probable infection at both the first (OR_depression = 1.62, P-value = 0.005; OR_anxiety = 1.59, P-value = 0.049; b_poorQoL = 1.34, P < 0.001; b_loneliness = 0.49, P < 0.001) and second (OR_depression = 1.56, P-value = 0.003; OR_anxiety = 1.55, P-value = 0.041; b_poorQoL = 1.38, P-value < 0.001; b_loneliness = 0.31, P-value = 0.024) COVID-19 assessments. Participants with probable infection also experienced greater financial difficulties than those without infection at the first assessment (OR = 1.50, P-value = 0.011). Probable COVID-19 infection is associated with longer-term deterioration of mental health and wellbeing and short-term increases in financial hardship among older adults. It is important to monitor the mental health of older people affected by COVID-19 and provide additional support to those in need.

Keywords: COVID-19 infection; financial hardship; mental health; older adults; social connections.

Fig. 1.

Associations of probable COVID-19 infection (June to July 2020) with mental health, financial hardship, and social connections (95% CIs) at the first and second COVID-19 assessments (June to July 2020 and November to December 2020). ELSA COVID-19 longitudinal sample (n = 5,146); pooled estimates and 95% CIs from logistic/linear regression models across 20 imputed datasets; estimates adjusted for sex, age, pre-COVID-19 outcomes, whether living alone, employment status, wealth, whether vulnerable to COVID-19, November or December 2020 COVID-19 infection (November to December 2020 outcome only), and limiting long-standing illness, and weighted using survey weights.

Fig. 2.

Estimated adjusted percentages and means of the outcomes at the first and second COVID-19 assessments (June to July 2020 and November to December 2020, respectively) in people with and without probable COVID-19 infection (June to July 2020). ELSA COVID-19 longitudinal sample (n = 5,146); pooled estimates and 95% CIs derived from linear/logistic regression models across 20 imputed datasets, adjusted for all covariates and prepandemic outcome scores and weighted using survey weights.

Fig. 3.

Interaction effects between probable COVID-19 infection and sociodemographic factors on wellbeing, financial hardship, and social connections. ELSA COVID-19 longitudinal sample (n = 5,146); pooled estimates and 95% CIs derived from logistic/linear regression models across 20 imputed datasets and weighted using survey weights; models adjusted for sex, age, pre-COVID-19 outcomes, whether living alone, employment status, wealth, whether vulnerable to COVID-19, November or December 2020 COVID-19 infection (November to December 2020 outcome only), and limiting long-standing illness and including interaction effects between COVID-19 infection and sociodemographic factors; only significant interaction effects (95% level) are reported.